DENIED !!!

I've heard talk of Capitol One doing financing. I feel so bad for you, I do... As far as your insurance goes, it's truly up to your employer to decide which procedures they will provide as a benefit. This is what the WL Coordinator at my surgeons' office had me do, call my insurance and ask "Is gastric bypass a COVERED BENEFIT UNDER THE TERMS of MY EMPLOYER's PLAN?" - I asked this over, and over, and over, as Cigna bounced me around to 6 different people. I knew the answer to be a true YES only when when I spoke to HR. CSR's at insurance companies can only give a vague answer unless they take the time to read and understand the terms of your policy to determine what is a covered benefit, and what is excluded, as well as what requirements must be met to have a certain procedure covered. I just looked on this website under the Insurance forum- here is the link for "U' in FL: http://www.obesityhelp.com/morbidobesity/members/list-insurers.php?State=FL&curPg=2&alphaP os=U It has tons of UHC approvals and denials as recent as Feb 06- so try not to panic yet. You have done all your research on the surgery, and you have been to an endo for treating the PCOS, right? Mine told me I have PCOS with Insulin resistance. Ok, so does a girl I work with who weighs 148 pounds!! PCOS is not a death sentence. There are support groups for PCOS- SOULCYSTERS I think is the name of one I read about. Great group of people. Do they have you on Glucophage? Have you been to a nutritionist? It's a syndrome- not an actual condition... (You prolly already know that) I think what I'm trying to say is what I'd hope someone else would say to ME if I posted a sad, venting, upset message. All is not lost. Take a deep breath. Call your HR department. They can turn the decision around if they want to. My LORD it's midnight and I've typed a book. Keep fighting! I wish you luck!!

Medipass will cover the surgery through medicaid. Especially if it is medically neccessary. I'm not sure if united is a state HMO. If so you'll have to file a greivance and then request to be transfered to medipass; for a good cause. I have 10 days left with staywell,then I can transfer to medipass. I see the surgeon on July 11, 2006. Good Luck!!!

I just saw in my insurance on top (blue tabs). A lady Christina Whales was approved recently by United Healthcare. Maybe you need to appeal. Put more pressure on them. Try emailing her and see how she did it. They pay alright. She just surgery in January.

I had my surgery approved thru United Healthcare. Are you sure it's not your job that has made the medical exclusion? My insurance approved 2 of us at our job but the next year the co-worker's brother finally decided to do it...and he said they didn't approve it so I looked it up and the COMPANY removed the "medically necessary" clause out of our policy whether it was the HMO or PPO (which sucks) but the exclusion came through the company and not the insurance. In any case - I wish you the best of luck..to bad you don't live closer my doc Overcash has the lowest cost in Fl for bariatric surgery. Again, good luck!

No, from what they tell me ..... Again there really hard to deal with... That United Healthcare just does NOT cover it anymore whatsoever !!! I dont know anymore.... Can you tell me when you had your surgery ? How long did it take to get approved ? Was a medical necessity ?

Christine, United Healthcare will pay. I'm having surgery Tuesday...YEAH!!....and I'm scheduled the same day with someone that is getting it paid by United Healthcare. The insurance company will tell you anything to discourage you. You should, however, call your HR Department, and make sure it hasn't been excluded from your insurance. I was turned down 3 times by AETNA, but it isn't because they wouldn't pay for it, they just ran me around forever. I'm actually getting mine through Medicare now. PLEASE.....don't let them discourage you because they will do whatever they can to make you stop. Just keep appealing, and find out what your policy says you need to have to support it. Liz

Did you have to keep appealing ? How long did it take to get approved ? Was it a medical necessity ?

I too have United Healthcare, and have also just rec'd my first denial. I talked to the Ins. Coordinator at Surgeons office, and she is telling me that in the last month she has seen a record number of DENIALS from United Health Care. It looks like things are changing with UHC and it is not for the good. I am currently trying to get a copy of my plan to see how I should approach this denial. Keep trying - I intend on exhausting every appeal to get my insurance company to cover part or all of this surgery, but I am also looking into other financing options because I will not let an insurance company dictate my health or my options. Best Wishes to you - and if you find a way to fight it - keep us posted. I will do the same.

Thanks for the support and all the information.... Keep it coming its been a great help !

Christine, Just wanted to let you know that I have United Health Care, they paid for my lap band back in July of 05 and they just paid for my revision over to the bypass 5/31/06. They also paid for my husbands lap band, and about 10 other employess of the same company who have had either the by pass or the lap band. And they were all this year. They DO cover WLS as long as your EMPLOYER has it included in their plan. Don't give up girl!! Fight for what you need and want!! I'll be praying for you and a quick turnaround from the insurance company!! If it's your employer that has it excluded from the plan you can appeal your human resource department to make an exception, sometimes that works!! Good luck and keep us posted!! Jo Ann